Friend or foe? The dual role of neutrophils in lung injury and repair

Grudzinska, Frances; Sapey, Elizabeth

doi:10.1136/thoraxjnl-2017-211253

Cited by 17 publications

(12 citation statements)

References 20 publications

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“…While our results are in agreement with other recent publications emphasizing the importance of the association of higher NLR with worse outcomes [8,13], this could represent a maladaptive response of the inflammatory cells in the setting of injury, where the NLR started at a lower value at admission and increased significantly over the following 48 h in this group. This could represent a clinical demonstration of other authors’ reports of the excessive release by neutrophils of elastase, damaging surrounding tissue [16,17], their involvement in tissue damage [18] and infiltration of remote organs contributing to multiple organ failures [19], thus resulting in worse outcomes in these patients. Our study is in line with Dilektasli et al, who demonstrated the prognostic role of NLR at days 2 and 5 in predicting in hospital deaths in trauma patients.…”

Section: Discussionsupporting

confidence: 53%

An Increasing Neutrophil-to-Lymphocyte Ratio Trajectory Predicts Organ Failure in Critically-Ill Male Trauma Patients. An Exploratory Study

et al. 2019

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Background: Although the association of neutrophil proportions with mortality in trauma patients has recently been shown, there is a paucity of research on the association with other outcomes. We sought to investigate the association of neutrophil proportions with organ failure in critically-ill trauma patients. Methods: We reviewed a randomly-selected group of trauma patients admitted to our level-1 trauma intensive care unit between July 2007 and December 2016. Data collected included demographics, injury mechanism and severity (ISS), neutrophil-to-lymphocyte ratio (NLR) at admission and at 24 and 48 hours and organ failure data. NLR patterns during the first 48 hours were divided into two trajectories identified by applying factor and cluster analysis to longitudinal measures. Logistic regression was performed for the association between NLR trajectories and any organ failure; negative binomial regression was used to model the number of organ failures and stage of kidney failure measured by KDIGO classification. Results: 207 patients had NLR data at all three time points. The average age was 44.9 years with mean ISS of 20.6. Patients were 72% male and 23% had penetrating trauma. The 74 patients (36%) with Trajectory 1 had a mean NLR at admission of 3.6, which increased to 14.7 at 48 hours. The 133 (64%) patients in Trajectory 2 had a mean NLR at admission of 8.5 which decreased to 6.6 at 48 hours. Mean NLR was different between the two groups at all three time points (all p < 0.01). There was no significant difference in ISS, age or gender between the two trajectory groups. Models adjusted for age, gender and ISS showed that relative to those with trajectory 2, patients with the trajectory 1 were more likely to have organ failure OR 2.96 (1.42–6.18; p < 0.01), higher number of organ failures IRR 1.50 (1.13–2.00, p < 0.01), and degree of AKI IRR 2.06 (1.04–4.06, p = 0.04). In all cases, the estimated associations were higher among men vs. women, and all were significant among men, but not women. Conclusions: Trauma patients with an increasing NLR trajectory over the first 48 hours had increased risk, number and severity of organ failures. Further research should focus on the mechanisms behind this difference in outcome.

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Section: Discussionsupporting

confidence: 53%

An Increasing Neutrophil-to-Lymphocyte Ratio Trajectory Predicts Organ Failure in Critically-Ill Male Trauma Patients. An Exploratory Study

et al. 2019

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“…Nonetheless, clinical and animal studies have shown that the activation of multiple inflammatory cells and the release of inflammatory mediators play important roles in the development and outcome of ARDS [5]. The involvement of immune cells, including neutrophils [6,7] lymphocytes [8], and regulatory T-cell [9,10], has become an active topic of research in ARDS pathogenesis. To date, few clinical studies on the immune status of ARDS patients have focused on aetiology, treatment and prognosis [11].…”

Section: (Continued From Previous Page)mentioning

confidence: 99%

Prognostic factors for ARDS: clinical, physiological and atypical immunodeficiency

Song

Liu

et al. 2020

BMC Pulm Med

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Background: Risk factors affecting the prognosis of acute respiratory distress syndrome (ARDS) in adults were investigated. The aim was to identify new predictors for ARDS patient prognosis, including those with clinical, pathophysiological, and atypical immunodeficiency. Methods: ARDS patients were retrospectively included. The patients were grouped and analysed according to different oxygenation index grades and prognosis, and factors influencing prognosis and survival were examined. Adolescent patients, patients with typical immunodeficiency and patients who died within 24 h after being diagnosed with ARDS were excluded. The predictive value for mortality was determined by Cox proportional hazard analysis. Results: In total, 201 patients who fulfilled the Berlin definition of ARDS were included. The severity of critical illness on the day of enrolment, as measured by the Acute Physiology and Chronic Health Evaluation (APACHE) II score (P = 0.016), Sequential Organ Failure Assessment (SOFA) score (P = 0.027), and PaO 2 /FiO 2 (P = 0.000), worsened from mild to severe ARDS cases. Compared with survivors, non-survivors were significantly older and had higher APACHE II and SOFA scores. Moreover, significantly lower lymphocyte/neutrophil ratios and leukocyte counts were found among non-survivors than survivors (P = 0.008, P = 0.012). A moderate positive correlation between the lymphocyte/ neutrophil and PaO 2 /FiO 2 ratios (P = 0.023) was observed. In predicting 100-day survival in patients with ARDS, the area under the curve (AUC) for the lymphocyte/neutrophil ratio was significantly higher than those for the PaO 2 / FiO 2 ratio alone, body mass index (BMI) alone, and the lymphocyte count alone (P = 0.0062, 0.0001, and 0.0154). Age (per log 10 years), BMI < 24, SOFA score, leukocyte count, and the lymphocyte/neutrophil ratio were independent predictors of 28-day mortality in ARDS patients. Additionally, ARDS patients with a lymphocyte/ neutrophil ratio < 0.0537 had increased 28-day mortality rates (P = 0.0283). Old age affected both 28-day and 100day mortality rates (P = 0.0064,0.0057).

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“…Acute lung injury is part of the main causes of morbidity and mortality associated with acute diseases (80). Massive neutrophil infiltration is a sign of acute lung injury and exposure to lung injury increases the level of ATP in the lung, indicating that activation of P2 receptors such as P2Y6 or P2X7 leads to increased inflammation and vascular leakage (81,82). Some genetic and pharmacological studies have confirmed that inappropriate activation of P2R signal is related to neutrophil-induced inflammation and tissue damage.…”

Section: Purinergic Signaling Of Neutrophils In Acute Lung Injurymentioning

confidence: 99%

Purinergic Signaling in Neutrophils During Inflammatory Diseases

Sun¹,

Xu²,

Li³

et al. 2020

Preprint

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Purinergic signaling is that nucleotides (especially ATP) and adenosine are utilized as transmitter molecules, which play an important role in the immune system. In the extracellular ventricle, ATP plays a significant role of pro-inflammatory molecules mainly through activating P2 receptors, while adenosine plays the role of anti-inflammatory molecules mainly through activating P1 receptors. As we know，neutrophils are the most abundant immune cells in our circulation and have become an essential part of coordinating a series of complex events during inflammatory diseases. However, due to the destruction of inflammatory substances from neutrophils, the activation of neutrophils is fine-tuned, and purinergic signaling is associated with this process. As a matter of fact, altering the balance between P2 and P1 signals is of great importance for neutrophils to exert immune activities properly. Here, we review the role of purinergic signaling in regulatory function of neutrophils during inflammatory disease, and then discuss the potential contribution of targeted purinergic signals in the treatment of the neutrophil during inflammatory diseases.

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Friend or foe? The dual role of neutrophils in lung injury and repair

Cited by 17 publications

References 20 publications

An Increasing Neutrophil-to-Lymphocyte Ratio Trajectory Predicts Organ Failure in Critically-Ill Male Trauma Patients. An Exploratory Study

An Increasing Neutrophil-to-Lymphocyte Ratio Trajectory Predicts Organ Failure in Critically-Ill Male Trauma Patients. An Exploratory Study

Prognostic factors for ARDS: clinical, physiological and atypical immunodeficiency

Purinergic Signaling in Neutrophils During Inflammatory Diseases

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